Clinic Reports, Three Cases
- Author:
Franklyn C. Paschal, A.M.,
Harrison Fellow in Psychology, Univ. of Penna. I. Ruth’s father recognized that she belonged in an institution, and asked the assistance of a physician in having her placed. He referred her to the social service department of a hospital, which in turn sent her to the Psychological Clinic. She was brought by her mother and another woman who served as interpreter.
Absolutely no history of any kind was brought out that might explain feeblemindedness. The families are healthy mentally and physically, while two older and several younger children are apparently normal. The parents were in good condition prior to her birth, and Ruth herself has had no illnesses that might be considered as causative.
By the time she was three years of age, her parents noticed that she was dull. She was a little slow in walking, very slow in learning to talk, was late in teething, and even now, at eight and a half years, has her first teeth with no signs of the second set. Her failure to attend to her needs was one of the first things noticed, but now she can care for herself at toilet. It is claimed by the mother that she can dress herself, though her slowness in buttoning a test frame would cause us to doubt that she can dress without assistance.
During the past year and eight months she has been in a special class, but has made no progress and gives trouble by biting other children. She has not learned to talk, except to use a few words in an almost unintelligible way. She has been in this country only a little over two years, it is true, but she should have made some progress in that time. Her play while under observation at the Clinic was not that of a normal child of three years. She twisted the arms and legs of a toy bear, and plucked at its eyes. She was very shy, and had a smile and expression of the eyes which were those of feeblemindedness rather than of shyness.
Ruth is microcephalic, the head girth being below the low frequency for five year old girls, and her cephalic index is unusually high, being 86. In her performance of mental tests the deficiency was particularly marked, the mental age on the Binet-Simon scale being less than three years. The only successful performances were placing the equal Seguin circles, and buttoning a Montessori frame, things which can be done by a two year old child. Attempts to educate her in the placing of a block in the Witmer formboard were a total failure; this is a thing which a normal child of eighteen months can be taught to do.
The diagnosis was superficial idiocy, congenital in origin, and permanent institutional care was recommended, though because she is not educable it is doubtful whether she would be received at any other place than the Philadelphia Hospital.
This case serves to demonstrate the value of the Witmer formboard as a didactic device in the determination of the level of feeblemindedness. The square was handed her and she attempted to place it in the circular recess. She was shown where it went, and put it away. It was immediately given to her again, and she once more tried it in the circle, and succeeded in placing it in the square only when told exactly where to put it. This was done seventeen times with no modification in the results.
II. A troublesome boy of eleven was brought by his mother at the suggestion of a social worker who had visited his home. Clarence is uncontrollable at home, defiant in school, and is continually fighting. The mother declares that other children and neighbors think him “dumb” and that his teacher says he “acts dumb” in school.
He is the fifth child of a family of eight, of which six are living. The father died of tuberculosis, as did an older brother of Clarence. A younger sister is now tubercular. Another brother has been in the University Hospital for the last year, with spinal tuberculosis. The mother is quite healthy. The parents, Russian Jews, came to this country about six years ago.
Clarence is now in good health, although he has a lengthy medical history. He has had a hernia operation and a broken leg, besides measles and whoopingcough. His pedagogical history has not been satisfactory. Three times he has been held back, but the reasons for this we could not discover. It seems that his illnesses and accidents have been mainly responsible. He seems to get along rather well when he is willing to work, but he is a serious problem from the disciplinary standpoint in the schoolroom. More information about the school history is desired, as the mother does not seem to be a good witness. Her use of English is somewhat limited) and her attitude toward the boy is far from the best.
The mental examination showed him to be of normal mentality, little below the average for his age.
The child’s difficulty seems to be the presence of conflicts. For one thing, Clarence has become Americanized much more rapidly than his mother. He does not want to talk to her in Yiddish, the language of the home, and they frequently have wordy arguments. During the examination, when one test was particularly well passed, the mother interposed, “Yes, you will do that for him, but when you are at home you are as dumb as you can be.” The mother seems like a capable woman, for she has managed a grocery store not her own, and has supported her family of six children with some assistance from the two older girls. Nevertheless, she does not know how to handle this boy. It is not improbable that the trouble at school is of a somewhat similar nature. He claims that he had satisfactory marks for conduct until he changed schools this year, and that he enjoyed the work in his former school, but now, “All they do is reading work all day.” He hates the Italian boys in the class, and is continually getting into fights with them.
This is the sort of case in which the Big Brother Movement is efficacious. Unless someone can gain control of Clarence, he will leave school as soon as he legally can, and may run away from home before that.
III. Peter is a fat, clumsy boy of five and a half years, so overgrown that he has the maximum height for a boy of seven, the maximum weight for a boy of ten, and the head girth of the average boy of fourteen. He has very poor muscular coordination, walks with a waddling gait, can step upward only when assisted, and also has poor control of the finer coordinations. He began to grow fat from his second year. Before that no abnormalities had been noticed. He was brought by a teacher in the kindergarten of a Deaconess Home, because his inability to make progress had given rise to a suspicion of mental deficiency.
His conduct is excellent. He is a very pleasant little fellow who tries to do as he is told, so far as he can understand, and he gets along well with other children, even at the expense of being imposed upon.
Peter’s language is very meagre; he uses few words and pronounces them indistinctly. Slavish is talked in the home, but less than English, and the boy speaks English only, refusing to answer his parents in Slavish. The parents are foreigners, and both work at poorly paid occupations. The mother, a native of Gallicia, is said to be a bright, capable woman. None of the ancestors, she says, were excessively fat. There was one older child who died as a result of fatty heart, having developed this condition at the age of two.
The mental examination showed that at the present time Peter’s mental status is not above the level of a low grade imbecile. By the Binet tests he has a mental age of three and a half years.
Because of the physical aspects of the case, the boy was sent to Dr Ludlum, who declared that his fatness suggested a tendency to acromegaly, and that he gave a rather myxoedematous picture. He recommended thyroid treatment for- a period of one month.
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